Implementation Update for Additional Multiple Procedure Payment Reduction to the Professional Component of Diagnostic Imaging Services

To better align with CMS, UnitedHealthcare will revise the current Radiology Multiple Imaging Reduction (RMIR) Policy for their Commercial plans to apply additional Multiple Procedure Payment Reductions (MPPR) to the professional component of secondary and subsequent diagnostic imaging services. This change will apply to claims with dates of service on or after Nov. 15, 2015. This policy expansion will apply a 25-percent reduction to the professional component (modifier 26) only and to the professional portion of global diagnostic imaging services. UnitedHealthcare is adopting the CMS reduction percentage of 25 percent for second and subsequent imaging services as an industry standard and to align with UnitedHealthcare’s Medicare Advantage and UnitedHealthcare Community Plan policies. Services will be ranked by the CMS Total Transitional Non-Facility Relative Value Unit (RVU). The services with the highest RVU will be considered primary, and services with the lower RVU will be considered secondary and subsequent. The MPPR will apply independently to the current technical component reduction. UnitedHealthcare will not apply professional component reductions when services are reported with modifier 59 or XE to identify different sessions.

Source: https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/News/August_Network_Bulletin_2015.pdf